原发性高血压患儿合并焦虑情绪的临床特征及相关因素

The clinical features and related factors of anxiety in children with essential hypertension

    摘要
  • 摘要:
    目的 探讨儿童原发性高血压合并焦虑情绪的临床特征及相关因素，为临床早期识别和干预提供依据。
    方法 回顾性收集2024年7月至2024年12月在首都医科大学附属首都儿童医学中心心血管内科住院的104例原发性高血压患儿的临床资料，通过儿童焦虑情绪障碍筛查量表评估患儿的焦虑情绪。根据有无焦虑症状，将研究对象分为高血压合并焦虑组和单纯高血压组，比较两组的临床资料。根据高血压分级标准将研究对象分为高血压1级组和高血压2级组，比较两组的焦虑量表得分情况。根据是否存在靶器官损害将研究对象分为无靶器官损害组和合并靶器官损害组，比较两组的焦虑量表得分情况。采用Spearman相关系数分析原发性高血压患儿的焦虑量表总分与血压水平的相关性；采用多因素logistic回归分析探索原发性高血压患儿合并焦虑情绪的相关因素。
    结果 本研究共纳入104例原发性高血压患儿，其中高血压合并焦虑组40例，单纯高血压组64例，高血压合并焦虑组的高血压2级占比62.50% （25/40）比40.62% （26/64），χ2 = 4.71，P = 0.03、焦虑量表得分30.00（25.00, 35.50）分比14.00（9.00, 19.00）分，Z = –8.56，P＜0.01、24 h收缩压134.00（126.00, 143.00）mmHg比125.00（121.75, 129.25） mmHg，Z = –4.98，P＜0.01、24 h舒张压77.00（74.00, 83.50）mmHg比74.00（70.00, 77.00）mmHg，Z = –3.07，P＜0.01、日间收缩压137.00（129.00, 145.00）mmHg比129.50（126.00, 133.00）mmHg，Z = –4.67，P＜0.01、日间舒张压80.00（75.75, 86.50）mmHg比77.00（73.00, 81.00）mmHg，Z = –2.73，P＜0.01高于单纯高血压组。高血压2级组的焦虑量表总分高于高血压1级组22.00（16.00, 29.00）分比16.00（11.00, 24.00）分，Z = –2.43，P = 0.02，合并靶器官害组的焦虑量表总分高于不合并靶器官损害组20.00（14.00, 26.75）分比15.00（9.00, 25.00）分，Z = –2.03，P = 0.04。Spearman相关性分析显示，24 h收缩压、24 h舒张压、日间收缩压、日间舒张压与焦虑量表总分均有相关性（r = 0.45，0.27，0.45，0.24，均P＜0.05）。多因素logistic回归分析显示，24 h收缩压升高是原发性高血压患儿合并焦虑情绪的独立相关因素（OR = 1.28，95%CI：1.13～1.44，P＜0.01）。
    结论 24 h收缩压升高是原发性高血压患儿合并焦虑情绪的独立相关因素，有助于早期识别高血压患儿的焦虑情绪，为高血压的个体化治疗与综合管理提供依据。

     

    Abstract:
    Objective To investigate the clinical characteristics and related factors of anxiety in children with essential hypertension, providing evidence for early identification and clinical intervention.
    Methods The clinical data of 104 children with essential hypertension who were hospitalized in the Department of Pediatric Cardiology, Capital Center for Children's Health, Capital Medical University from July 2024 to December 2024 were retrospectively collected, and the anxiety symptoms in the children were assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED). Based on the presence or absence of anxiety symptoms, the patients were divided into the hypertension with anxiety group and the hypertension group. The clinical data of the two groups were compared. The patients were divided into the stage 1 hypertension group and the stage 2 hypertension group based on the hypertension classification criteria, and the anxiety scale scores were compared between the two groups. According to the presence or absence of target organ damage (TOD), the patients were categorized into the non-TOD and the TOD group, with anxiety scale scores subsequently compared between these two groups. The Spearman correlation coefficient was used to analyze the correlation between the total score of the SCARED and blood pressure level in children with essential hypertension. Multivariate logistic regression was used to explore the independent related factors of anxiety in children with essential hypertension.
    Results A total of 104 children with essential hypertension were included in this study, including 40 cases in the hypertension with anxiety group and 64 cases in the hypertension group. The proportion of hypertension stage 2 (62.50%25/40 vs 40.62% 26/64, χ2 = 4.71, P = 0.03), the total score of the SCARED (30.00 25.00, 35.50 points vs 14.00 9.00, 19.00 points, Z = –8.56, P＜0.01), 24 h systolic blood pressure (SBP) (134.00 126.00, 143.00 mmHg vs 125.00 121.75, 129.25 mmHg, Z = –4.98, P＜0.01), 24 h diastolic blood pressure (DBP) (77.00 74.00, 83.50 mmHg vs 74.00 70.00, 77.00 mmHg, Z = –3.07, P＜0.01), daytime SBP (137.00 129.00, 145.00 mmHg vs 129.50 126.00, 133.00 mmHg, Z = –4.67, P＜0.01), daytime DBP (80.00 75.75, 86.50 mmHg vs 77.00 73.00, 81.00 mmHg, Z = –2.73, P＜0.01) in the hypertension with anxiety group were significantly higher than that of the hypertension group. The total score of the SCARED in the stage 2 hypertension group was higher than that of the stage 1 hypertension group (22.00 16.00, 29.00 points vs 16.00 11.00, 24.00 points, Z = –2.43, P = 0.02), and the total score of the SCARED in the TOD group was higher than that of the non-TOD group (20.00 14.00, 26.75 points vs 15.00 9.00, 25.00 points, Z = –2.03, P = 0.04). Spearman correlation analysis showed that 24hSBP, 24hDBP, daytime SBP and daytime DBP were correlated with the total score of the SCARED (r = 0.45, 0.27, 0.45, 0.24, all P＜0.05). Multivariate logistic regression analysis showed that elevated 24hSBP was an independent related factor for anxiety in children with essential hypertension (OR = 1.28, 95%CI 1.13 to 1.44, P＜0.01).
    Conclusions Elevated 24hSBP is an independent related factor for anxiety in children with essential hypertension. It helps in the early identification of anxiety in children with essential hypertension, providing a basis for the individualized treatment and comprehensive management of hypertension.

     

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